Making integrated care happen | Michael Macdonnell

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Michael Macdonnell, national director of health system transformation at NHS England, discusses integrated care and building on the work from the vanguard programme.

The NHS celebrates its 70th anniversary this year. Quite rightly, it’s a source of national pride and its values still hold as strong today as they did in 1948.

But while we look back at past successes, we should also look forward to the next 70 years. I hope that 2018/19 will be a significant turning point in the NHS’s evolution, as we move away from focusing solely and individually on GP practices, hospitals and other organisations, towards building integrated systems. This is necessary if we’re going to shift from an episodic, ‘see and fix’ model of care delivery to one that’s better attuned to the 15 million (and growing) people with long-term conditions.

In April, a number of areas across England will start to operate as integrated care systems: NHS bodies collaborating with each other and with their local authorities to take collective responsibility for the health of their populations. These systems will address systemic challenges like taking the strain off of urgent and emergency services, strengthening general practice and improving cancer and mental healthcare.

They will use population health management approaches to redesign services that improve prevention and help communities to be more active, building their confidence and ability to manage their own health. In systems as diverse as Greater Manchester, Buckinghamshire and Lancashire, integrated care teams are already acting earlier to reduce hospital attendances and admissions among patients at risk.

The cornerstone of population health will be networks of primary care working together to enhance access and deliver proactive care through integrated teams of pharmacists, nurses, mental health therapists and other professionals.

But NHS trusts are also shaping a new future for themselves. Some are collaborating with their neighbours to ease workforce pressures, share assets and standardise care. Others are integrating ‘vertically’, connecting GPs and consultants in ‘extensivist’ teams that provide patients with joined-up care whether they’re at home or on the ward. Mental health and community services also need to become much more integrated with hospitals and practices.

As the 2018/19 planning guidance set out, integrated care systems will be backed by greater flexibilities and financial incentives. For example, from next year onwards integrated care systems will receive sustainability funding only if they deliver as a system. These systems will also benefit from a more grown-up regulatory relationship as they take on greater autonomy for managing their own performance.

Many of these new systems are building on the work of the new care models programme and vanguards in their areas. The values, achievements and learning from the programme have been critical to testing the ‘art of the possible’. The vanguards demonstrate that if you empower local systems to lead change in their community, with some national support to overcome common barriers, real progress can be made.

We have seen slower growth in emergency hospital admissions and emergency hospital bed days in those vanguard areas compared to the rest of England. For multispecialty community provider vanguards, emergency admissions grew by 2.6 per cent in July-September 2017, with the rest of England at 4.9 per cent.

For integrated primary and acute care systems vanguards, emergency admissions grew by 1.2 per cent in the same period compared to 4.9 per cent for the rest of England. For the enhanced health in care homes vanguards, emergency admissions for care home residents dropped by 1.4 per cent while admissions for the rest of the England went up by 6.7 per cent.

On top of this, we’ve seen many examples of improved patient experience by developing more personalised care. We’ve seen new clinical leaders emerge, embracing the opportunity to innovate and do things differently for the benefit of patients. We’ve heard many accounts of a reinvigorated workforce, working effectively in integrated teams across organisational boundaries.

Integrated care systems are learning from these successes. And we are already seeing results, from Dorset to Frimley to South Yorkshire and Bassetlaw. Integrated services and more investment in primary care are paying off by keeping people well and out of hospital. This in turn helps the NHS live within the resources at its disposal.

Of course there is still plenty of pressure out there. But we’ve known for a long time that more integrated models of care – that provide more support to the people most at risk of becoming acutely unwell – are part of the answer. We now need to translate this consensus into concerted action across the NHS. As the saying goes, to will the ends is to will the means.

Michael Macdonnell is national director of health system transformation at NHS England. Follow him on Twitter @Michael_Mac_UK

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